Project Description

Project No.: Enter project #	Route: Enter route #

Control Sec.: Enter control sec.	Parish: Enter Parish

Project Name: Enter project name

Description of Work: Enter project location and description. Use shift+enter to start a new paragraph.

General Information

Reason for waiver

EDSM

MANUAL

OTHER (Describe)

Provide a synopsis of the scope of the project, the situation you are encountering and the problem you are attempting to mitigate.

Provide description.

Describe the proposed design waiver. Provide the proposed and standard values of the design waiver criteria.

Provide description.

Required Signitures

Recommended by: DESIGNER Please Print	Date:
Signature:

Recommended by: Position Please Print	Date:
Signature:
Recommended by: Project Manager Please Print	Date:
Signature:
Approved by: Applicable DOTD Section Head Please Print	Date:
Signature: